Health insurance must pay for exoskeletons

boing
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There are issues with that, if I recall. You have to be licensed or certified or something to provide durable medical equipment. I looked into it for a patient with bilateral leg prosthetics. (She had a stroke, lost a bunch of weight, but since she’d been given prosthetics a year before the insurance refused for another 7 years. Despite the fact that large weight loss rendered her current legs useless. She went from walking by herself to needing a wheelchair.)

I think the prosthetic guys said half the cost was wound up in being appropriately certified. I’m a prop guy, so I was thinking we could cast her legs, and vacuum form a new plastic sheath, and the prosthetics guy said it’s totally doable, but to actually sell the stuff, you have to have the right paperwork, and that costs.

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That’s the law. But fuck the law.

Yes. That’s what I expected.

That’s what under-the-table black/gray/barter/whatever market should be for.

Together with opensource blueprints and 3d-printing-ready parametric (OpenSCAD?) models to make it easier for anybody who’s around and has the equipment and wants to help and/or needs a little cash.

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There are some prosthetic diy makers out there. I think Boing Boing has promo’d them before. The kids lego prosthetic maker, the 3D kids super hero arm makers, and I even read about a way to heat 2 liter bottles and shape them on yourself as a way to make a vacuum formed fitted sheath, without the vacuum forming.

I would love to see more black market, underground, diy prosthetic makers. After my nursing time, and watching stuff, like on the bicycle courier in NY city, whose leg was stolen, and couldn’t get another one from insurance for another five years, it breaks my heart to see people not get what they need.

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I prefer the term “grey” (and I prefer the UK spelling, too) because black market has a negative connotation. If the free market approach to health care isn’t going to help people, then let them try other options.

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Good to know if my leg goes to total shit I can get robot legs.

I can’t promise to be on humanity’s side during the robot revolt.

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Again, playing devil’s advocate, but Canada, the UK, Japan, Spain, and others I’m sure all have reimbursement plans and review boards regarding new medical device technology. You can’t just waltz in with your National Health card and get handed a free ReWalk.

An expensive technology like this, with a much cheaper and established alternative like a motorized wheelchair, is gonna be a pretty tough sell even in a socialized medicine environment.

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And of course, the ReWalk competes with a number of other devices that purport to solve the same problems, through various means,

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So if your employer did this for your company insurance, you’d still work there and wouldn’t leave for another employer?

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For medical devices? Uhm, no.

How is there no way to measure the outcome?

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Why not? Isn’t a homemade opensource device you can have better than one with your own weight in certifications and licensing that you can not afford?

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Not if it kills or harms you. There is the reason that medical devices go through a thorough examination.

I know you’re all “fuck the law” but unless you’re doing it to your own body, there are ethical implications.

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Which cuts both ways. You have to weigh the risk of doing something vs doing nothing.

The same implications are linked even to refusing help. You can make a mistake, yes, you can screw up, yes, but you can also have to watch the results of not doing anything - which is all nice and legal but can have even worse results at the end.

Edit: but doing nothing and just watching, because The Law says so, is so comfortable and safe…

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That depends on which side you are looking at things.

Think of your insurance premiums and what the insurance company is going to have to pay out as something akin to a 401k. Obviously the more money you can keep invested early on will yield a much larger return over the life of the invest, er I mean person. This $75k hit to the principal early on may do more damage to the investment in 20 years than what medical expenses they would incur without it. Realistically that’s all being calculated by fancy statistical software that turns human lives into a dollar based calculation…

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It’s not just not spending the $75K, it’s also how else we could spend that same amount. So give the person a $30K wheelchair and use the other $45K to treat obesity or cancer or burn victims.

You do essentially want to see some “bang for your buck.” And what you want is a standard and agreed-upon process for that, which the rejection / arbitration / IRB process is.

Also there’s not exactly a ton of research on what “medical expenses are going to be incurred” by not using this technology.

Here’s Canada’s health board assessment of the Rewalk:

https://www.cadth.ca/rewalk-robotic-exoskeletons-spinal-cord-injury

“Benson et al. reported a high incidence of skin issues. Five grade 1 skin aberrations occurred in three participants, and 10 grade 2 aberrations occurred in five participants. All of the skin aberrations resulted in interruptions to the training program, and two participants were forced to withdraw because of recurring skin issues.”

“Esquenazi et al. mentioned instances where users lost their balance and either saved themselves from falling or were stabilized by staff.12 The same authors also reported instances where the device misfired and failed to step, a situation that might lead to an adverse event. This deficiency has reportedly been addressed by the manufacturer. Benson et al. cautioned that the continuous expert supervision characteristic of clinical environments may underestimate the real risk of falls and fractures in community settings.”

“Another study indicated that most participants reported a slight increase in pain after using the exoskeleton and that, overall, the device did not meet participant expectations regarding perceived benefits and impact on quality of life.”

“No participants achieved walking velocities close to those necessary to safely cross a road.”

“Despite these potential advances, wheelchairs are likely to remain the most important mobility technology for people with SCI for at least the next decade.”

“As of early 2015, ReWalk Robotics reported 99 devices in service worldwide”

I think it’s safe to say that the insurance company had a lot of good reasons for sending this to an IRB.

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What about the Math department?

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Realistically, non-white folks are going to rise up all over the world and murder white folks for centuries of abuse before the robots get to the job.

I can’t say it won’t be deserved either.

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The robots already got the jobs. Look at any bigger factory.

Even the factory I work/consult for, while substantially relying on manpower, is significantly automated. I admit some maintenance on the robots was my work, too.

When the robot uprising comes, I’m quite likely to be on the side of the machines; hopefully at least half-merged with one by then because human body sucks.

And if the non-whites start murdering whites, well, then my weapons/gunsmithing/ballistics knowledge will have to become more than mere fun. The ones who really win a war are the ones who survive it - it’s less important who was right than who is left.

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Corrected.

o_0 non-white people have been killing each other and others since the dawn of humanity as well.

It will never happen in a large scale, at least not in the US, because 1) most people aren’t homicidal maniacs and 2) they are grossly outnumbered and outgunned.

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Want.